Breastfeeding and Lactation Management

Learning Objectives

  • Understand why breast feeding is important
  • Physiology of mammogenesis and lactogenesis
  • Characteristics of human milk
  • Technique of breast feeding
  • Assessment of adequacy of breastfeeding
  • Management of common breastfeeding problems

Introduction

As per the IYCF1 guidelines,

  • Exclusive breast feeding till 6 months of age
  • Sustained breastfeeding with adequate complementary feeding till 2 years of age

  • Major challenge - Failure of exclusive breastfeeding (Only 30-40%)

Why is breastfeeding important?

  • Perfect Nutrients
  • Easily digested and efficiently used
  • Protects against infection

  • Helps bonding and development
  • Helps delay a new pregnancy
  • Improves the mother’s health

Immune Benefits

  • Secretory IgA and other immunoglobulins
  • Antiviral and antibacterial factors
  • Cellular immune components
  • Cytokines, including interleukins
  • Enzymes
  • Nucleotides

Immune benefits

Prevention of infections

Other Benefits

  • Acute otitis media
  • Non-specific gastrointestinal infections
  • Severe lower respiratory tract infections
  • Atopic dermatitis
  • Asthma
  • Obesity
  • Type 1 and type 2 diabetes
  • Childhood leukemia
  • Sudden infant death syndrome
  • Necrotising Enterocolitis
Condition Risk Reduction (%)
Acute Otitis Media 50%
(EBF > 3-6 mo)
Atopic Dermatitis 42%
(EBF > 3 mo)
Gastroenteritis 64%
(Any BF vs none)
LRTI 72%
(EBF > 4 mo)
Asthma 40%
(BF > 3 mo)
Condition Risk Reduction (%)
Obesity 24%
(Any BF)
Type 1 DM 30%
(BF > 3 mo)
Type 2 DM 40%
(Any BF)
ALL/AML 20% / 15%
(BF > 6 mo)
SIDS 36%
(BF > 1 mo)

Breastfeeding Management

Feeding policy

Exclusive breastfeeding for 6 months

  • Breastfeeding preferred; alternatively expressed mother’s milk, or donor breast milk
  • To continue for at least the first year and beyond as long as mutually desired by mother and child
  • Complementary foods rich in iron and other micronutrients should be introduced at about 6 mo of age

Feeding of infants

Infant feeding

Hospital Policies

Skin-to-Skin Contact

  • Immediately after delivery until the first feeding is accomplished
  • Encourage throughout postpartum period

Routine Procedures

  • Should always be DELAYED until first feeding completed
  • Includes weighing, documentation (foot imprints) and vaccines
  • Vitamin K - delay administration till after the first feeding completed (within the 1st 6 hours of birth)

Feeding Practices

  • Ensure 8-12 feedings at the breast every 24 hours
  • Formal evaluation and documentation of breastfeeding1 including position, latch, milk transfer, examination at least once for each nursing shift.
  • NO Supplements permitted (water, glucose water, infant formula, or other fluids) to infants unless medically indicated2 for hypoglycemia or hyperbilirubinemia.
  • NO routine use of pacifiers

Post Discharge policy

Review by Pediatrician1

Parents to be asked to review after 48 to 72 hours.

  • Evaluation of hydration and elimination patterns
  • Evaluation of weight gain
  • Discussion of maternal issues
  • Observe feeding

Care at home

  • Mother and child should sleep in close proximity to each other to facilitate breastfeeding
  • Supine position while sleeping
  • Encourage feeding at night
  • Use of galactogogues may be considered